As we have seen, there was some debate over whether private asylums offered a greater likelihood of curing insanity than the district sector.
Those attempting to appease contemporary public alarm over wrong-ful or prolonged confinement in private asylums maintained that it was in the financial interest of proprietors to cure as many patients as pos-sible in as short a time as pospos-sible. The strategy of treating insanity both promptly and successfully was also aspired to in English contexts, where, as Parry-Jones has found, it could serve as an ‘effective advertisement’
for a private asylum.160 Critics’ claims that private asylums provided little more than custodial care, rather than cure, were therefore often mislead-ing.161 In reality, those investing high sums in the care of their relatives would have anticipated fast, effective results. When such an outcome was not forthcoming, patients were frequently removed to alternative places of care.
Evidence abounds that private asylums tended to achieve high rates of discharge and even cure for private patients. Between 1826 and 1867, most patients whose length of stay at Bloomfield (63.5%) and Hampstead (69.9%) is known stayed for less than one year. These figures are almost identical to those for the two oxfordshire private asylums at Hook Norton and Witney (62% and 66% respectively) and higher than the York Retreat (approx. 40–50%) in this period.162 Digby has inter-preted such high patient turnover as evidence against contemporary anxi-eties about the silting up of asylums with chronic, long-stay cases, while Parry-Jones contends that it goes some way towards refuting accusations of the prolonged confinement of private patients for corrupt motives including financial gain.163 These arguments also apply in the Irish con-text. As shown in Table 3.5, from 1868 to 1900, the majority of patients admitted to the asylums studied spent short periods there. Not unlike patients admitted to the York Retreat,164 Irish private asylum patients, in particular, tended to stay for less than one year (67.1%), as did two-thirds of male and over one-half of female paying patients admitted to the district asylums. This compares favourably with district asylums in this period. For example, in her study of the Armagh, Belfast, omagh and Sligo asylums, Malcolm has found that at most, half of the patients admitted stayed for twelve months or less.165 Meanwhile, longer stays of five years or more were slightly less common among paying patients than total district asylum populations.166
The likelihood of dying in the asylum was less for private and vol-untary asylum patients than for paying patients sent to district asylums.
Like patients at the Witney asylum, in the earlier period, one-tenth of patients admitted to Hampstead and Bloomfield died in the asylum.167 While a larger proportion of Hook Norton patients (21.9%) died there, Parry-Jones has related this disparity to the reception of paupers to this institution, among whom a number were admitted suffering with chronic or intractable physical and mental conditions.168 This reason-ing also explains the differences in mortality rates in Irish asylums. While between 1868 and 1900, 20.1% of patients admitted to the private asy-lums and 30% of those admitted to voluntary asyasy-lums died there, 40.9%
of paying patients admitted to the district asylums suffered a similar fate (see Table 3.6). References to poor bodily health were far more fre-quent in the case notes for paying patients admitted to Enniscorthy and Richmond than to the voluntary and private asylums studied. In fact, dis-trict asylum paying patients seemed especially vulnerable, even compared with some ‘pauper’ populations, such as the Sligo asylum, where one-third of admissions between 1855 and 1893 died.169 Yet, while death rates among the district asylum paying patients decreased slightly over the period examined, Finnane has found that, by 1901, nearly half of dis-trict asylum patients were dying.170
The most notable difference in outcome in the Irish context was the proportion of cures, which was reportedly significantly higher in Irish Table 3.5 Known length of stay for patients admitted to the district, voluntary and private asylums studied, 1868–1900a
Compiled from Belfast, Ennis, Enniscorthy, Richmond, Stewarts, Bloomfield, St John of God’s, Hampstead and Highfield admissions registers
aThe first admission to St John of God’s was in 1885
District Voluntary Private
F (%) M (%) T (%) F (%) M (%) T (%) F (%) M (%) T (%) Less than
1 year 52.9 66.3 60.9 59.4 56.3 58.3 62.2 67.6 67.1 1–5 years 22.8 17.0 19.3 22.3 22.0 22.2 20.3 20.0 20.0
5–10 years 9.1 4.9 6.6 7.0 10.8 8.4 6.8 3.0 3.4
10 + years 15.2 11.8 13.2 11.3 10.8 11.1 10.8 9.4 9.6 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
N = 276 407 683 471 277 748 74 700 774
private asylums than in English ones. Between 1826 and 1867, half of patients admitted to Bloomfield and Hampstead were discharged cured and a further fifth improved or relieved. By comparison, 27% of private patients admitted to Hook Norton, 35% to Witney and between 35 and 44% to the York Retreat were ‘cured’ during the same period.171 As was the trend in other asylums, most of those recorded as cured were released within one year of admission (78.7% at Bloomfield and 82.1%
at Hampstead). In the later period, almost half of the private asylum patients were discharged cured, while one in three were discharged from the voluntary and district asylums under this description (see Table 3.6).
In her discussion of patient outcomes at Ticehurst, MacKenzie has chal-lenged Scull’s contention that private asylum cure rates were ‘abysmally low’, showing that some 60–80% of admissions were discharged, while 16–39% were discharged recovered. However, as MacKenzie concedes, this was low compared with recovery rates at less expensive asylums including the Retreat, lending some credence to Scull’s argument that
‘money could not buy health’.172 At the Retreat during the same era, recovery rates were roughly one-third of admissions.173 This reveals that
Table 3.6 Known outcome of stay for patients admitted to the district, volun-tary and private asylums studied, 1868–1900a
Compiled from Belfast, Ennis, Enniscorthy, Richmond, Stewart’s, Bloomfield, St John of God’s, Hampstead and Highfield admissions registers
aThe first admission to St John of God’s was in 1885
District Asylums Voluntary Asylums Private Asylums F (%) M (%) T (%) F (%) M (%) T (%) F (%) M (%) T (%) Cured/
Recovered 31.6 33.4 32.7 33.1 31.2 32.4 46.1 48.6 48.3 Improved/
Relieved 17.4 20.0 18.9 26.9 20.8 24.7 19.7 13.4 14.1 Not
Improved/
Not Relieved
6.7 7.9 7.4 13.3 12.3 12.9 0.0 3.8 3.4
Not Cured/Not Recovered
0.0 0.0 0.0 0.0 0.0 0.0 10.5 5.6 6.1
Died 44.3 38.6 40.9 26.7 35.7 30.0 23.7 28.6 28.1
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
N = 253 365 618 465 269 734 76 640 716
Irish private asylum patients had better chances of being cured, or at least of being described as cured, than their English counterparts. Irish voluntary and district asylums, meanwhile, were keeping pace with, if not outperforming, the renowned York Retreat when it came to cure rates for paying patients.
of course, discharge did not always signal the end of institutionalisa-tion for patients. of the 2368 patients admitted to the asylums studied between 1868 and 1900, 284 (12.0%) were identified as readmissions. In contrast to Malcolm’s finding that patients readmitted to district asylums were commonly committed several times before being committed perma-nently to die in the institution, the outcome for readmissions in this study tended to be more positive than that for first admissions.174 overall, half (50.8%) were cured compared with 36.3% of first admissions, while fewer died (22.7% of readmissions; 33.9% of first admissions).
As Cox has pointed out, discharge rates have been largely neglected in the Irish context.175 Her finding that 42.8% of admissions to the Carlow asylum between 1832 and 1922 were discharged ‘recovered’ thus pro-vides the only point of reference.176 While recovery rates for paying patients admitted to the district and voluntary asylums are comparably low, the proportion of patients discharged as ‘relieved’ is much higher (18.9 and 24.7% respectively) than the 6.9% at Carlow.177 Moreover, given the higher death rates in district asylums, it is plausible that the private and voluntary asylums tended to produce more cures or partial improvement than the district ones.
The large proportion of those discharged ‘relieved’, ‘not relieved’
or ‘not recovered’ in this study suggests that the families of fee-paying patients tended to withdraw them prematurely, probably to lessen the financial burden of asylum care.178 As we have seen, families often went to great lengths to pay for relatives’ care in these institutions, while for many a fast recovery was all their limited means could afford. This ech-oes Walsh’s suggestion that relatives viewed asylums as a resource to be used when needed.179 For families with greater disposable funds who were displeased with the outcome of care in one asylum, the institutional marketplace offered many alternatives.
The transfer of patients to other institutions was not uncommon.
Despite wide disparities in maintenance fees and standard of accommo-dation, the boundaries between district, voluntary and private asylums were extremely permeable and patients were transferred between the three sectors. Reasons for transfer varied. Understandably a change in
economic circumstances could prevent continued accommodation at a private or voluntary asylum and result in a patient being moved to an institution charging lower rates. Although data on transfers in the asylum records is patchy, case notes for both Stewarts and Bloomfield patients, resident during the 1890s, contain a field marked ‘where and when pre-viously under care’, allowing for some analysis. The information pro-vided also takes into account patients who had been discharged from one institution and then later admitted to another.
The Stewarts case notes reveal that a number of patients admit-ted there had previously spent time in district asylums. This cohort tended to pay lower sums (£30–£60 p.a.) in the voluntary asylums, although not exclusively. For example, three women were transferred from Richmond, where they had been contributing £14, £15 and £24 17s. 8d. per annum respectively, to Stewarts, where they were charged between £50 and £52 per annum each. However, patients admitted to Bloomfield and Stewarts were most likely to be transferred from a pri-vate asylum, suggesting reduced circumstances or simply decreased con-fidence in the efficacy of private asylum care were reasons for the move.
Patients transferred from private asylums usually paid between £50 and £100 at the voluntary asylums, although some were maintained at higher rates on a par with private asylum fees. For example, four years after his discharge from Hampstead House, Cecil W.W., a twenty-two year-old, single, ship-builder’s apprentice was admitted to Bloomfield in September 1896. There he was charged £160 per annum but after one year it was recorded that Cecil had ‘been visited lately a good deal by his sisters and uncle, and yesterday was removed to Dr. Eustace’s’.180 Similarly, Henrietta Sophia M., a forty year-old single woman was sent by her brother to Bloomfield in April 1893 at £100 per annum. She had previously been a patient in the Crichton Royal Institution in Dumfries from September 1891 to 1892. This case was not unusual. Several vol-untary asylum patients had previously been accommodated in asylums in Britain, including Morningside, West Riding and Crichton. These patients tended to pay average rates in the voluntary asylums, lending weight to the lunacy inspectors’ claims that wealthier families often chose to send relatives to Britain where private asylums charged more com-petitive rates.181 After she was discharged from Crichton, Henrietta had stayed ‘in various places’ where she was reportedly ‘excited, crying much and talking incessantly of herself and her misfortunes’. Henrietta gave an account of her experience at Crichton:
Whenever I see her she talks about herself constantly, saying she is quite sane and that her troubles and the bad treatment she says she got at Dumfries have made her nervous and excited … Is very unhappy. Says she was ruined by the cruelty she received in Dumfries and that she needed lively and happy society and was just improving when sent here.
While in Bloomfield, the physician reported that:
Some days she stays in bed. others gets up, but would not go out except once for a few minutes. She says she cannot work, read, or do anything as long as she is here, and that the sight of a lunatic would make her die…
She cries loudly. She tears her fingers till they bleed and is dirty in hab-its, wetting her things frequently. She wants to leave, but when at liberty before coming here she says she was in much the same state as now.
By November, it was reported that Henrietta was to be moved to a pri-vate asylum in Finglas.182 In these instances, the high fees paid for Cecil and Henrietta confirm that families with considerable disposable income had the luxury of selecting between institutions.
c
onclusionsThis chapter has shown that district, voluntary and private asylums oper-ated in an institutional marketplace. Within this marketplace, families held the purse strings. of the three groups, relatives negotiating with district asylums exerted the least influence and were subject to thorough and sometimes intrusive investigations into their financial circumstances.
Although the lunacy inspectors criticised asylum boards for failing to identify patients with means, this chapter has revealed that the boards went to great lengths to identify those who could afford to contribute.
The boards did, however, demonstrate compassion for those genuinely in need of relief, as these patients were legally entitled to accommodation based on their mental condition rather than their ability to pay fees. This conforms to Cox’s findings in the context of the Carlow and Enniscorthy districts.183 Ultimately, however, and as Cox has found for Carlow and Enniscorthy, the proportion of revenue generated from patient contribu-tions was small.184
Families possessed of greater means had more influence in the mar-ketplace and the managing bodies of voluntary and private asylums were
compelled to tailor accommodation and maintenance fees to the needs of their clientele. This eventually resulted in competition between the voluntary and private sector in the 1890s, as evidenced by the decision of Stewarts’ and Bloomfield’s managing committees to provide more expensive and luxurious accommodation and to advertise. This resulted in part from the establishment of less expensive private asylums including St John of God’s. It was also a consequence of the economic downturn of the 1880s and 1890s: families who might once have availed of private care were now forced to consider less expensive options. These devel-opments in turn affected private asylums. Although the lunacy inspec-tors frequently criticised private asylum proprieinspec-tors who charged lower fees, the combined effects of the economy and competition from volun-tary asylums meant that they were increasingly under threat of closure.
This is in spite of the higher proportion of patients cured at the private asylums studied, which would have sat well with contemporary private asylum proprietors anxious to guard against accusations of wrongful or over-lengthy confinement. While in the English context Parry-Jones has characterised private asylum proprietors as ‘remarkably charitable’ for charging some patients low rates, this chapter has highlighted that, at least in Ireland, proprietors were anxious to safeguard their asylums’ rep-utation of care.185 Thus, by 1900, many of the more prestigious asylums had shifted their target market to encompass less affluent socio-economic groups.
n
otes1. Cox (2012), pp. 97–132, 148, 154–159, Wright (1998), Finnane (1981), pp. 175–220; Walton (1979–1980), pp. 1–22.
2. Cox (2012), p. 23.
3. Malcolm has traced similar developments in the history of St Patrick’s:
Malcolm (1989), pp. 118–120.
4. Smith (1999a), (1999b). See also Melling and Forsythe (2006).
5. W.S. Studdert to R.P. Gelston, 26 Jul. 1888 (CCA, our Lady’s Hospital, oL1/7 Letter 1489).
6. For example, James K. to R.P. Gelston, 10 Jan. 1893 (CCA, our Lady’s Hospital, oL1/7 Letter 1883).
7. For example, J. Coffey Ryan to R.P. Gelston, 18 Jun. 1894 (CCA, our Lady’s Hospital, oL1/7 Letter 2025b). For more on the role of medical officers in the Irish medical dispensary system see Cox (2010), pp. 57–78.
8. Fortieth Report of the Inspectors of Lunatics (Ireland), H.C. 1890–
1891, p. 521.
9. Minute Books (CCA, our Lady’s Hospital, oL1/1); Medical Superintendent Memorandum Books (WCC, St Senan’s Hospital, Enniscorthy); Minutes of the Governors of Enniscorthy District Lunatic Asylum (WCC, St Senan’s Hospital, Enniscorthy).
10. Medical Superintendent Memorandum Books, 1868–1889 (WCC, St Senan’s Hospital, Enniscorthy, p. 239).
11. For example, Rough Minute Book, 1867–1871 (CCA, our Lady’s Hospital, oL1/24/4, 14 Sep. 1871); Minute Book, 1878–1881 (CCA, our Lady’s Hospital, oL1/1/2, pp. 246, 378); Minute Book, 1888–
1891 (CCA, our Lady’s Hospital, oL1/1/5, p. 216).
12. Some correspondence books for this period are not extant.
13. 38 & 39 Vic., c. 67, s. 16.
14. For example, Fred G. Kerin, Solicitor to RMS, Ennis, 26 Aug. 1898 (CCA, our Lady’s Hospital, oL1/7 Letters 2504a and 2504b).
15. For example, Medical Superintendent Memorandum Book, 1868–1889 (WCC, St Senan’s Hospital, Enniscorthy, pp. 48, 389, 436), 38 & 39 Vic., c. 67, s. 16.
16. Minute Book No. 13, 1872–1877 (NAI, Richmond District Lunatic Asylum, p. 80).
17. Ibid., p. 343.
18. Minutes of the Governors of Enniscorthy District Lunatic Asylum, 1883–1898 (WCC, St Senan’s Hospital, Enniscorthy, pp. 16, 50).
19. Minute Book No. 14, 1877–1881 (NAI, Richmond District Lunatic Asylum, pp. 185–186).
20. For example, Minute Book, 1874–1880 (CCA, our Lady’s Hospital, oL1/1/1, p. 218).
21. Minute Book, 1880–1885 (CCA, our Lady’s Hospital, oL1/1/3, p. 331).
22. Michael B. to Governors of the Lunatic Asylum, Ennis (CCA, our Lady’s Hospital, oL1/7 Letter 1657); Minute Book, 1888–1891 (CCA, our Lady’s Hospital, oL1/5, p. 286).
23. Michael B. to the Governors of the Lunatic Asylum Ennis, 13 Jun. 1890 (CCA, our Lady’s Hospital, oL1/7 Letter 1657).
24. See Minute Book, 1898–1902 (CCA, our Lady’s Hospital, oL1/1/8, pp. 17, 27, 216); Letter from J. Garry to Dr. o’Mara, 21 Dec. 1899 (CCA, our Lady’s Hospital, oL1/7 Letter 2706).
25. 38 & 39 Vic., c. 67, s. 16.
26. Cox (2012), p. 181.
27. Ibid., p. 182.
28. Clerk of Union, Workhouse, Tulla to R.P. Gelston, 14 Sep. 1892 (CCA, our Lady’s Hospital, oL1/7 Letter 1857).
29. 38 & 39 Vic., c. 67, s. 9.
30. See Cox (2012), pp. 181–183.
31. Ibid., p. 22.
32. Pat F. to R.P. Gelston, 3 Nov. 1892 (CCA, our Lady’s Hospital, oL1/7 Letter 1866).
33. J. Culligan JP to Ennis District Asylum, 29 Nov. 1894 (CCA, our Lady’s Hospital, oL1/7 Letter 2054).
34. H.S. Land Agency office, Galway to R.P. Gelston (CCA, our Lady’s Hospital, oL1/7 Letter 2469).
35. Ellen D. to The Secretary, Asylum, Ennis, 3 Dec. 1883 (CCA, our Lady’s Hospital, oL1/7 Letter 984).
36. R.D. o’Brien to R.P. Gelston, 17 Nov. 1888 (CCA, our Lady’s Hospital, oL1/7 Letter 1519).
37. Cox (2012), pp. 99, 102.
38. Henry P.R to Governors of Ennis Asylum, 3 Jun. 1884 (CCA, our Lady’s Hospital, oL1/7 Letter 1045).
39. Henry P.R to R.P. Gelston, 28 May 1888 (CCA, our Lady’s Hospital, oL1/7 Letter 1471); Henry P.R., to R.P. Gelston, 27 Apr. 1889 (CCA, our Lady’s Hospital, oL1/7 Letter 1560).
40. Minute Book, 1870–1882 (PRoNI, Purdysburn Hospital, HoS/28/1/1/4, p. 101).
41. Ibid., p. 111.
42. For example, Medical Superintendent Memorandum Book, 1868–1889 (WCC, St Senan’s Hospital, Enniscorthy, p. 198).
43. Medical Superintendent Memorandum Book, 1868–1889 (WCC, St Senan’s Hospital, Enniscorthy, p. 176).
44. Minute Book No. 14, 1877–1881 (NAI, Richmond District Lunatic Asylum, p. 206).
45. Cox (2012), p. 22.
46. For example, Ibid., pp. 37–38, 43.
47. For example, Minute Book, 1880–1885 (CCA, our Lady’s Hospital, oL1/1/3, p.158); Minute Book, 1891–1894 (CCA, our Lady’s Hospital, oL1/1/6, p. 213); Minute Book, 1894–1898 (CCA, our Lady’s Hospital, oL1/1/7, pp. 333, 393); Rough Minute Book, 1867–1871 (CCA, our Lady’s Hospital, oL1/2/4, 14 Nov. 1868, 12 Dec. 1868); Minute Book, 1874–1880 (CCA, our Lady’s Hospital, oL1/1/1, pp. 2, 17).
48. Cox (2012), p. 20.
49. Finnane (1996), p. 97.
50. For example, Minute Book, 1870–1882 (PRoNI, Purdysburn Hospital, HoS/28/1/1/4, p. 120); Minute Book, 1874–1880 (CCA, our Lady’s Hospital, oL1/1/1, p. 176); Medical Superintendent Memorandum Book, 1868–1889 (WCC, St Senan’s Hospital, Enniscorthy, pp. 137, 404, 487, 496).
51. Medical Superintendent Memorandum Book, 1868–1889 (WCC, St Senan’s Hospital, Enniscorthy, p. 109).
52. office of Lunatic Asylums to R.P. Gelston (CCA, our Lady’s Hospital, oL1/7 Letter 1707).
53. Medical Superintendent Memorandum Book, 1868–1889 (WCC, St Senan’s Hospital, Enniscorthy, p. 138).
54. Minutes of the Governors of Enniscorthy District Lunatic Asylum, 1883–1898 (WCC, St Senan’s Hospital, Enniscorthy, p. 99).
55. For example, Minute Book No. 13, 1872–1877 (NAI, Richmond District Lunatic Asylum, pp. 134–135).
56. Minutes of the Governors of Enniscorthy District Lunatic Asylum, 1883–1898 (WCC, St Senan’s Hospital, Enniscorthy, pp. 138, 145).
57. Ibid., p. 183.
58. For example, Minute Book, 1882–1893 (PRoNI, Purdysburn Hospital, HoS/28/1/1/5, p. 130).
59. Thelma F. to R.P. Gelston, 5 Aug. 1892 (CCA, our Lady’s Hospital, oL1/7 Letter 1845).
60. James K. to Board of Governors, Ennis District Asylum, 13 Jan. 1899 (CCA, our Lady’ Hospital, oL1/7 Letter 2569).
61. R.H. Little, Parish Priest to the Chairman, Board of Governors, District Asylum Ennis, 13 Jan. 1899 (CCA, our Lady’s Hospital, oL1/7 Letter 2569a).
62. Admissions Register (CCA, our Lady’s Hospital, oL3/1.3).
63. John C. to the Chairman and Board of Governors, Ennis Lunatic Asylum, 9 Feb 1894 (CCA, our Lady’s Hospital, oL1/7 Letter 1987).
64. Minute Book, 1891–1894 (CCA, our Lady’s Hospital, oL1/1/6, p. 336).
65. Denis o’F to the Governors of Ennis District Lunatic Asylum, 1889 (CCA, our Lady’s Hospital, oL1/7 Letter 1536a).
66. Patrick McM to R.P. Gelston, Jan. 1890 (CCA, our Lady’s Hospital, oL1/7 Letter 1624).
67. James W. to R.P. Gelston, Nov. 1889 (CCA, our Lady’s Hospital, oL1/7 Letter 1600); James K. to Board of Governors, Ennis Asylum, May 1892 (CCA, our Lady’s Hospital, oL1/7 Letter 1820).
68. D. Flannery, Parish Priest to R.P. Gelston, 6 Dec. 1889 (CCA, our Lady’s Hospital, oL1/7 Letter 1613).
69. For more on charity in nineteenth–century Ireland, see Walsh (2005), Luddy (1995); Preston (2004).
70. James Cahir, Parish Priest to RMS Ennis, 7 Apr. 1899 (CCA, our Lady’s Hospital, oL1/7 Letter 2606).
71. James Cahir, Parish Priest to Ennis Asylum, 13 May 1892 (CCA, our Lady’s Hospital, oL1/7 Letter 1815a).
72. Cox (2012), p. 23.
73. In 1888, there were a G.S. Studdert and R.M. Studdert on the Ennis board of governors.
73. In 1888, there were a G.S. Studdert and R.M. Studdert on the Ennis board of governors.